| dc.description.abstract | Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and the single biggest cause of cervical cancer, as well as certain cancers of the head and throat, anus, vulva, vagina, and penis. Between 2008 and 2012 nearly 40,000 people annually were diagnosed with an HPV-related cancer. Despite these staggering numbers and the existence of a highly effective vaccine, HPV vaccination rates remain low. In the first chapter, I study how the structure of school mandate opt-outs can affect vaccine take-up. I show that Washington, DC’s movement from a one-time opt-out provision to an annual requirement increased the probability that teen girls were vaccinated against HPV by 11 percentage points. Teen boys were 20 percentage points more likely to be vaccinated. In the second chapter, I show that state Medicaid expansions as part of the Affordable Care Act (ACA) were associated with a 3-4 percentage point increase in the probability that teens initiated the HPV vaccine. This relationship appears to have been driven in part by increases in Medicaid coverage, the probability of having a recent check-up, and knowledge about the HPV vaccine. Supporting this pathway, I show that Medicaid expansion states saw increased Google searches for “pediatrician,” “Gardasil” (a trade name of the HPV vaccine), and “HPV Cancer.” Because teen insurance eligibility was largely unaffected by the ACA Medicaid expansions, this chapter highlights the importance of parental engagement with the health care system in affecting teen health behaviors and outcomes. Finally, in the third chapter, I study state policies requiring employers to electronically verify (E-Verify) the work eligibility of their new hires. I show that state E-Verify mandates were associated with a 5-percentage point reduction in the probability that likely-unauthorized immigrants were employed and a 2-percentage point reduction in the probability that they had employer-sponsored insurance. However, these changes appear to have been mitigated by selective outmigration of otherwise unemployed and uninsured likely-unauthorized immigrants. | |
